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Is one health insurance company better than the others?

by root shed

Everyone tends to want the “best” of everything they get. This is also true with regards to health insurance. Although with health insurance folks tend to want to get the best but not pay for it. Sadly, just like with all other products you tend to pay a bit more for the best products.

One reality though is that it tends to be harder to differentiate between health insurance product with the same plan design and another. It tends to boil down to the provider network, claims payments, and the customer service provided to the physicians and the members. Most folks decide on their health insurance plan based on plan design and premium charged. Of course all of my comments relate to major medical health insurance.

Premium for any given plan is driven in part on costs from the provider network as well as the expectations for care needs based on the underwriting review of the application. It is possible that your will receive a premium surcharge if you are less healthy than other members to help cover your expected increased costs. It may be depending on your medical issue that one carrier will hit you with a greater surcharge than another network will and that often can drive some of the premium costs.

In the case of two plans with generally the same plan design the overall outcome of choosing one plan over the other tends to be driven by premium. Of course your key physician being in a network or not may in your eyes differentiate between the plans as one being better than the other. But, in reality, that does not really make one plan better or not than the other.

Ultimately, what plan is best is really in the eyes of the buyer. But to help decide what seems best for you, it helps to look at well matched plans, ones that are of the same style (PPO or H.S.A. based) and at the same deductible per person and per family both on the in and out of network basis. Then get the accurate price for the plans you are considering. Then match the provider networks based on your needs. Once you have these things all lined up, pick the plan that looks best to you.

Unless you know specific negative issues with one carrier over another it is hard to really push one aside as being not as good. All of them will raise rates each year to some degree or another. Thus the lowest priced plan today may not remain the lowest priced plan tomorrow. To that end, lowest price does not equate to best plan or even best network discounts.

Ultimately it helps to use a professional advisor to help you pick your plan as they know the unique aspects of each plan and carrier and can guide you to a choice best fitting your personal needs. This is helpful especially when provider networks and medical conditions complicate the plan decision.

With the new plans we will see in 2014 and the ability to buy coverage on and off the exchanges, it will become in some ways even harder to tell which carrier will be the best. Reform though did create documents in a more standard format making it a bit easier to examine one plan compared to another. Healthcare reform may well standardize benefits of the plans on the exchange and perhaps even off. Thus in a year it may really just boil down to price differences.

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